A comparative evaluation of normal tissue doses for patients receiving radiation therapy for Hodgkin lymphoma on the Childhood Cancer Survivor Study and recent Children's Oncology Group trials

Rachel Zhou, Angela Ng, Louis S. Constine, Marilyn Stovall, Gregory T. Armstrong, Joseph P. Neglia, Debra L. Friedman, Kara Kelly, Thomas J. FitzGerald, David C. Hodgson

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Abstract

Purpose Survivors of pediatric Hodgkin lymphoma (HL) are recognized to have an increased risk of delayed adverse health outcomes related to radiation therapy (RT). However, the necessary latency required to observe these late effects means that the estimated risks apply to outdated treatments. We sought to compare the normal tissue dose received by children treated for HL and enrolled in the Childhood Cancer Survivor Study (CCSS) (diagnosed 1970-1986) with that of patients treated in recent Children's Oncology Group (COG) trials (enrolled 2002-2012). Methods and Materials RT planning data were obtained for 50 HL survivors randomly sampled from the CCSS cohort and applied to computed tomography planning data sets to reconstruct the normal tissue dosimetry. For comparison, the normal tissue dosimetry data were obtained for all 191 patients with full computed tomography-based volumetric RT planning on COG protocols AHOD0031 and AHOD0831. Results For early-stage patients, the mean female breast dose in the COG patients was on average 83.5% lower than that for CCSS patients, with an absolute reduction of 15.5 Gy. For advanced-stage patients, the mean breast dose was decreased on average by 70% (11.6 Gy average absolute dose reduction). The mean heart dose decreased on average by 22.9 Gy (68.6%) and 17.6 Gy (56.8%) for early- and advanced-stage patients, respectively. All dose comparisons for breast, heart, lung, and thyroid were significantly lower for patients in the COG trials than for the CCSS participants. Reductions in the prescribed dose were a major contributor to these dose reductions. Conclusions These are the first data quantifying the significant reduction in the normal tissue dose using actual, rather than hypothetical, treatment plans for children with HL. These findings provide useful information when counseling families regarding the risks of contemporary RT.

Original languageEnglish (US)
Pages (from-to)707-711
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume95
Issue number2
DOIs
StatePublished - Jun 1 2016

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Hodgkin Disease
Survivors
radiation therapy
Radiotherapy
cancer
dosage
evaluation
Neoplasms
breast
Breast
planning
dosimeters
tomography
Cone-Beam Computed Tomography
Counseling
lungs
Thyroid Gland
health
Cohort Studies
Tomography

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A comparative evaluation of normal tissue doses for patients receiving radiation therapy for Hodgkin lymphoma on the Childhood Cancer Survivor Study and recent Children's Oncology Group trials. / Zhou, Rachel; Ng, Angela; Constine, Louis S.; Stovall, Marilyn; Armstrong, Gregory T.; Neglia, Joseph P.; Friedman, Debra L.; Kelly, Kara; FitzGerald, Thomas J.; Hodgson, David C.

In: International Journal of Radiation Oncology Biology Physics, Vol. 95, No. 2, 01.06.2016, p. 707-711.

Research output: Contribution to journalArticle

Zhou, Rachel ; Ng, Angela ; Constine, Louis S. ; Stovall, Marilyn ; Armstrong, Gregory T. ; Neglia, Joseph P. ; Friedman, Debra L. ; Kelly, Kara ; FitzGerald, Thomas J. ; Hodgson, David C. / A comparative evaluation of normal tissue doses for patients receiving radiation therapy for Hodgkin lymphoma on the Childhood Cancer Survivor Study and recent Children's Oncology Group trials. In: International Journal of Radiation Oncology Biology Physics. 2016 ; Vol. 95, No. 2. pp. 707-711.
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abstract = "Purpose Survivors of pediatric Hodgkin lymphoma (HL) are recognized to have an increased risk of delayed adverse health outcomes related to radiation therapy (RT). However, the necessary latency required to observe these late effects means that the estimated risks apply to outdated treatments. We sought to compare the normal tissue dose received by children treated for HL and enrolled in the Childhood Cancer Survivor Study (CCSS) (diagnosed 1970-1986) with that of patients treated in recent Children's Oncology Group (COG) trials (enrolled 2002-2012). Methods and Materials RT planning data were obtained for 50 HL survivors randomly sampled from the CCSS cohort and applied to computed tomography planning data sets to reconstruct the normal tissue dosimetry. For comparison, the normal tissue dosimetry data were obtained for all 191 patients with full computed tomography-based volumetric RT planning on COG protocols AHOD0031 and AHOD0831. Results For early-stage patients, the mean female breast dose in the COG patients was on average 83.5{\%} lower than that for CCSS patients, with an absolute reduction of 15.5 Gy. For advanced-stage patients, the mean breast dose was decreased on average by 70{\%} (11.6 Gy average absolute dose reduction). The mean heart dose decreased on average by 22.9 Gy (68.6{\%}) and 17.6 Gy (56.8{\%}) for early- and advanced-stage patients, respectively. All dose comparisons for breast, heart, lung, and thyroid were significantly lower for patients in the COG trials than for the CCSS participants. Reductions in the prescribed dose were a major contributor to these dose reductions. Conclusions These are the first data quantifying the significant reduction in the normal tissue dose using actual, rather than hypothetical, treatment plans for children with HL. These findings provide useful information when counseling families regarding the risks of contemporary RT.",
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AU - Constine, Louis S.

AU - Stovall, Marilyn

AU - Armstrong, Gregory T.

AU - Neglia, Joseph P.

AU - Friedman, Debra L.

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N2 - Purpose Survivors of pediatric Hodgkin lymphoma (HL) are recognized to have an increased risk of delayed adverse health outcomes related to radiation therapy (RT). However, the necessary latency required to observe these late effects means that the estimated risks apply to outdated treatments. We sought to compare the normal tissue dose received by children treated for HL and enrolled in the Childhood Cancer Survivor Study (CCSS) (diagnosed 1970-1986) with that of patients treated in recent Children's Oncology Group (COG) trials (enrolled 2002-2012). Methods and Materials RT planning data were obtained for 50 HL survivors randomly sampled from the CCSS cohort and applied to computed tomography planning data sets to reconstruct the normal tissue dosimetry. For comparison, the normal tissue dosimetry data were obtained for all 191 patients with full computed tomography-based volumetric RT planning on COG protocols AHOD0031 and AHOD0831. Results For early-stage patients, the mean female breast dose in the COG patients was on average 83.5% lower than that for CCSS patients, with an absolute reduction of 15.5 Gy. For advanced-stage patients, the mean breast dose was decreased on average by 70% (11.6 Gy average absolute dose reduction). The mean heart dose decreased on average by 22.9 Gy (68.6%) and 17.6 Gy (56.8%) for early- and advanced-stage patients, respectively. All dose comparisons for breast, heart, lung, and thyroid were significantly lower for patients in the COG trials than for the CCSS participants. Reductions in the prescribed dose were a major contributor to these dose reductions. Conclusions These are the first data quantifying the significant reduction in the normal tissue dose using actual, rather than hypothetical, treatment plans for children with HL. These findings provide useful information when counseling families regarding the risks of contemporary RT.

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